Emergency Medical Training & Care
Page

1 of 4

MARCH 13, 2006 (13-34)
MARCH 13, 2006 (13-43)

CORRECTIONS CORPORATIONOFAMERICA
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

METRO-DAVIDSON COUNTY DETENTION FACILITY

Bill Andrade, MD
Chief Medical Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Ricllard P. Seiter
Executive Vice President/Chief Corrections Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

MARCH 10, 2008

JULY 6,2006

G.A. Puryear, IV
Executive Vice President/General Counsel

13-34.1 POLICY:
During hours of operation, the CCA Health Services Department will provide emergency response and
medical care for inmates/residents. For facilities not providing health services on a 24/7 basis, security
staff will provide emergency response and arrange for proper outside assistance. Basic first aid and
stabilization will be provided to employees and visitors to the facility until relieved by an outside provider.
13-34.2 AUTHORITY:
CCA Company Policy
13-34.3 DEFINITIONS:
Clinical Emergency- The sudden development of a clinical situation requiring urgent evaluation and/or
treatment when delay would reasonably be expected to threaten life, limb, or bodily functions.
Inmate/Resident - Any adult or juvenile, male or female housed in a CCA facility. Inmates/residents
may also be referred to as detainees, prisoners or offenders depending on classification and in
accordance with facility management contracts.
13-34.4 PROCEDURES:
PROCEDURES INDEX
SECTION
A
B -C
D
E

A.

HEALTH RELATED TRAINING
1.

EXHIBIT

SUBJECT
Health Related Training
Emergeocy_Da[e
Emergency Transportation
Emen::Jency Notification
Documentation

Under the gUidance and direction of the responsible Health Authority, and in
cooperation with the Warden/Administrator, security personnel will receive on-going
health-related training. At a minimum, training will include:
a.

First-aid administration;

b.

Early recognition of life-threatening emergencies (asthma, heart conditions,
hemorrhage, etc.);

c.

Recognition of signs/symptoms of certain chronic illnesses and conditions
(seizures, diabetes, pulmonary disease, adverse reactions to medications);

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B.

OCTOBER 22, 2007

13-34

d.

Recognition of signs/symptoms of mental illness, retardation, and chemical
dependency;

e.

Suicide precautions;

f.

Appropriate medical referral procedures;

g.

Recognition and precautions regarding infections and communicable diseases;

h.

Cardio Pulmonary Resuscitation (CPR), and Automatic External Defibrillator
(AED) training by instructors certified by the American Heart Association or
American Red Cross;

i.

Bloodborne Pathogen Exposure Control Plan; and

j.

Violent behavior.

2.

Verification of training/continuing education including dates offered; description of
training; instructor(s); and attendance record will be maintained in accordance with CCA
Policy 4-2, Maintenance of Training Records.

3.

All licensed healthcare staff, correctional officers, and other staff must maintain current
CPR certification, as issued by instructors certified by the American Heart Association
or American Red Cross.

EMERGENCY CARE
1.

In the event of an emergency illness/injury, on-site emergency care will be provided by
any and all qualified facility personnel, as soon as possible. When additional care is
required, staff will provide immediate first-aid, basic life support, and/or stabilization as
indicated.

2.

Licensed healthcare staff, correctional officers, and other staff are trained to respond to
emergencies within a four (4) minute time frame.

3.

Mobile emergency drugs and equipment are maintained and easily accessible for
emergency care, to include the Automatic External Defibrillator (AED).

4.

To assist in emergency care, an emergency response kit will be maintained by the
health services department. At a minimum, the emergency response kit will contain the
items listed on the 13-34B Emergency Response Kit - Inventory. Facilities may add
items with the approval of the Regional Director, Health Services.

.- ..- - - - - . - - - - -..-.--.. - - - a . - - ! h e -..1.3,,34B_Emergency_Response_Kit::lmLentor.y__wiU.b.e_maintaloe.Q.....w..itb_tb!L..__...._
emergency response kit.

5.

C.

b.

The 13-34B will be completed each time the emergency response kit is
accessed.

c.

The inventory must be checked after each use.

The 13-34C Emergency Record will be maintained with the emergency response kit.
Upon arrival to the emergency location, ttl-a responding health services staff member
will designate an individual to complete the 13-34C. The 13-34C will be used as a tool
to document pertinent and accurate times and data and is not to be placed in any
medical record.

EMERGENCY TRANSPORTATION
1.

Each facility is responsible for providing a written agreement between the facility and
EMS transportation entity.

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OCTOBER 22, 2007

13-34

2.

In the event that the medical staff is not on duty, the facility senior staff member will
initiate/coordinate immediate transportation to the appropriate health care institution,
utilizing the outside EMS.

3.

Facility staff will assist responding EMS personnel until the inmate/resident(s) is safely
in the emergency vehicle.

4.

Inmates/residents with life-threatening conditions will be transported to the closest
emergency institution via EMS.
AT THIS FACILITY, THE CLOSEST RECEIVING INSTITUTION IS:

I

SOUTHERN HILLS MEDICAL CENTER

5.

A CCA vehicle may be used to transport inmates/residents whose condition is not life
threatening and who are stabilized for transport. Transport and medical escort
determination will be made by the Health Services staff or designee.
AT THIS FACILITY, THE USUAL PREFERRED NON-EMERGENCY INSTITUTION IS:

I

NASHVILLE GENERAL HOSPITAL

D.

E.

EMERGENCY NOTIFICATION
1.

Emergency numbers will be posted in a readily accessible area in the nurse's station.
Each facility will have a formal notification system posted.

2.

On-call health personnel and all other designated staff will be notified of any Iifethreatening injury or emergency transport.

3.

Facility staff will notify the receiving institution and contracting agency (if required) by
telephone as soon as transport arrangements are completed.

DOCUMENTATION
1.

Health services staff will ensure that all documentation is completed in a timely manner
and entered infO
into the inmatelresiaent's meaicarrecora-.----------------------------

2.

The applicable 13-34A1 Facility Emergency Flow Sheet (Le. Inmate/Resident or
Employee) and the 13-34A2 Facility Emergency Anatomical Form will be completed by
health services staff.

3.

Additional documentation will be made in the 13-588 Health Services Progress Notes
that details all events as they occurred.

4.

In the event the emergency care requires the completion of an incident packet in
accordance with CCA Policy 5-1 Incident Reporting, a copy of the 13-34A2 will be
provided to security personnel for inclusion in the incident packet.

13-34.5 REVIEW:

The Chief Medical Officer or qualified designee will review this policy on an annual basis.

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OCTOBER 22, 2007

13-34

13-34.6 APPLICABILITY:
All CCA Facilities (Provided contractual requirements do not mandate otherwise)
13-34.7 APPENDICES:
None
13-34.8 ATTACHMENTS:
13-34A1 Facility Emergency Flow Sheet - Inmate/Resident
13-34A1 Facility Emergency Flow Sheet- Employee
13-34A2 Facility Emergency Anatomical Form
13-348

Emergency Response Kit - Inventory

13-34C

Emergency Record

13-588

Health Services Progress Notes

13-34.9 REFERENCES:
CCA Policy 4-2
CCA Policy 5-1
CCA Policy 13-58
ACA

4-4348/4-ALDF-4C-05
4-4349/4-ALDF-4C-06
4-4351 M/4-ALDF-4C-08M/ 3-JTS-4C-24M/3-JCRF-4C-14M
4-4389M/4-ALDF-4D-08M/3-JTS-4C-28M/3-JCRF-4C-15M
3-JCRF-4C-17

NCCHC P-A-07E/J-A-07E
P-C-04E/J-C-04E
P-D-05/J-D-05
P-E-08E/J-E-08E

LD.3.70
LD.3.80
ECA.10
EC.9.30
HR.2.10
HR.2.30
HRA.20
OSHA 29CFR 1910.1030

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Health Appraisals

13

CORRECTIONS CORPORATIONOFAMERICA.
CORPORATIONOFAMERICA

OCTOBER 22, 2007

13-40

Page

1 of 3

MARCH 13, 2006

METRO-DAVIDSON COUNTY DETENTION FACILITY

SIGNATURE ON
ON FILE
FILE AT
AT FACILITY
SUPPORT CENTER
CENTER
SIGNATURE
FA CILITY SUPPORT

Bill Andrade, MD
Chief Medical Officer

SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Richard P. Seiter
Executive Vice President/Chief Corrections Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

MARCH 10,2008

JULY 6,2006

G.A. Puryear, IV
Executive Vice President/General Counsel

13-40.1 POLICY:
All new inmates/residents will have an initial and periodic health appraisal performed or reviewed in
accordance with the guidelines in this policy.
13-40.2 AUTHORITY:
CCA Company Policy
13-40.3 DEFINITIONS:
Inmate/Resident - Any adult or juvenile, male or female housed in a CCA facility. Inmates/residents
may also be referred to as detainees, prisoners, or offenders depending on classification and in
accordance with facility management contracts.
Intrasystem Transfer - An inmate/resident who is transferred from one facility to another in the same
system, returning from furlough, or brought to the facility with an established health record for their
current incarceration.
Licensed Independent Practitioners (LIP) - Physicians, Physician's Assistant, Advanced Registered
Nurse Practitioner, Dentist, and Psychiatrist. Each LIP shall perform duties according to the state scope
of practice guidelines.
13-40.4 PROCEDURES:
PROCEDURES INDEX
--SECTION- SECTIONA
B
A.

EXHIBIT

SUBJEGT
Health Appraisal
Time Guidelines

----------------------------------

HEALTH APPRAISAL
1.

Initial and periodic health appraisals will be completed and documented in accordance
with the 13-40A Inmate/Resident Health Appraisal.

2.

A health appraisal will include the following:
a.

Review of initial screening data;

b.

Diagnostic testing, to include communicable disease as applicable;

c.

Vital signs, height, and weight;

d.

Directed physical exam including mental status and inquiry of dental problems;

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B.

13-40

e.

Investigation regarding substance abuse;

f.

Based upon inmate/resident's age and risk factors, breast, pelvic, rectal, and
testicular exams;

g.

Review of findings;

h.

Initiation of therapy/immunizations, when appropriate;

i.

Treatment plan, if indicated; and

j.

Other tests and examinations as clinically indicated.

TIME GUIDELINES
1.

Initial Health Appraisals
a.

A comprehensive health appraisal for each inmate/residents, excluding
intrasystem transfers, will be completed, by a Physician or LIP, within fourteen
(14) days of arrival to the facility. In the event there is documented evidence
that the inmate/resident has received a health appraisal within the previous
ninety (90) days, a new health appraisal is not required unless otherwise
determined by the designated health authority.
NOTE: NCCHC accredited facilities will complete health appraisals as
follows:

i.

Prisons - All inmates/residents will receive a comprehensive initial
health appraisal as soon as possible, but no later than seven (7)
calendar days.

ii.

Jails - All inmates/residents will receive a comprehensive initial health
appraisal as soon as possible, but no later than fourteen (14) calendar
days.
NOTE: All intrasystem transfers will receive a medical, dental, and
mental health screening in accordance with CCA Policy 13-50. To
ensure continuity of care a qualified health services staff will review the
medical record and document the review in the medical record. A new
health appraisal is not required unless otherwise determined by the
designated health authority.

2.

Periodic Health Appraisals

---_.

a.

Certain elements of the health appraisal will be repeated at an appropriate
frequency as determined by the responsible physician in consideration of the
age, gender, and health needs of inmates/residents in the popUlation.

b.

At a minimum, a periodic health appraisal will be offered every three (3) years
for inmates/residents above the age of sixty (60), unless otherwise specified in
customer agreements, or as indicated by the patient's health status.
AT THIS FACILITY, THE TIME GUIDELINES FOR PERIODIC HEALTH
APPRAISALS AS MANDATED BY CONTRACT ARE:

13-40.5 REVIEW:

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OCTOBER 22, 2007

13-40

The Chief Medical Officer or qualified designee will review this policy on an annual basis.
13-40.6 APPLICABILITY:
All CCA Facilities (Provided contractual requirements do not mandate otherwise)
13-40.7 APPENDICES:
None
13-40.8 ATTACHMENTS:
13-40A

Inmate/Resident Health Appraisal

13-40.9 REFERENCES:
CCA Policy 13-50
ACA

4-4365M/4-ALDF-4C-24M/3-JTS-4C-24-3M
4-4366/4-ALDF-4C-25/3-JTS-4C-25/3-JCRF-4C-'11
4-4367/4-ALDF-4C-26

NCCHC

P-E-03E/J-E-03E
P-E-04E/J-E-04E
P-E-13/J-E-13

JCAHO

PC.2.20
PC.3.230
PC.15.30

Current CDC TB Guidelines

-------------------_.

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Health-Related Training Foil' Staff

13

13-43

CORRECTIONS CORPORATION OFAMERICA
METRO-DAVIDSON COUNTY DETENTION FACILITY

SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Bill Andrade, MD
Chief Medical Of/icer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Richard P. Seiter
Executive Vice President/Chief Corrections Of/icer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

JULY 6,2006

FEBRUARY 17, 2005

G.A. Puryear, IV
Executive Vice President/General Counsel

13-43.1 POLICY:
CCA will provide staff with training so that they may be aware of potential emergencies, have the ability
to respond to life-threatening situations, and understand their role in the early detection of serious
illness and injury.
13-43.2 AUTHORITY:
CCA Company Policy
13-43.3 DEFINITIONS:
None
13-43.4 PROCEDURES:
PROCEDURES INDEX
SECTION
A

B
A.

SUBJECT
Health Related Training
Health Related Drills (CPR)

HEALTH RELATED TRAINING
1.

Under the guidance and direction of the responsible Health Authority, and in
cooperation with the Warden/Administrator, security personnel will receive on-going
health"related-training....Ala_milJimum,Jeainlog will include:
a.

First-aid administration;

b.

Early recognition of life-threatening emergencies (asthma, heart conditions,
hemorrhage, etc.);

c.

Recognition of signs/symptoms of certain chronic illnesses and conditions
(seizures, diabetes, pulmonary disease, adverse reactions to medications);

d.

Recognition of signs/symptoms of mental illness, retardation, and chemical
dependency;

e.

Suicide precautions;

f.

Appropriate medical referral procedures;

g.

Recognition and precautions regarding infections and communicable diseases;

EXHIBIT

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B.

MARCH 13, 2006

13-43

h.

Cardio Pulmonary Resuscitation (CPR), and Automatic External Defibrillator
(AED) training by instructors certified by the American Heart Association or
American Red Cross;

i.

Bloodborne Pathogen Exposure Control Plan; and

j.

Violent behavior.

2.

Verification of training/continuing education including dates offered; description of
training; instructor(s); and attendance record will be maintained in accordance with CCA
Policy 4-2, Maintenance of Training Records.

3.

Security personnel will maintain current CPR training and/or certification, as issued by
instructors certified by the American Heart Association or American Red Cross.

HEALTH RELATED DRILLS (CPR)
Mock CPR drills will be conducted to establish an automatic set of responses by all staff to a
cardiopulmonary emergency.
1.

CPR drills will be conducted quarterly on each shift and participation is mandatory.

2.

CPR drills will include a minimum of one (1) scenario involving a suicide attempt by
hanging each year for each shift.

3.

The HSA in coordination with the Facility Safety Authority or Manager, Quality
Assurance will plan drills utilizing the 13-43AA Cardio Pulmonary Resuscitation Drill
Plan.

4.

Upon completion of the drill, the Facility Safety Authority or Manager, Quality Assurance
and HSA will evaluate the drill utilizing the 13-43A Mock Cardio Pulmonary
Resuscitation Evaluation Log.

5.

The 13-43B Emergency Record will be utilized to document pertinent and accurate
times and data.

6.

All completed forms will be forwarded to the Warden/Administrator for review and
maintained on file.

13-43.5 REVIEW:

The Chief Medical Officer or qualified designee will review this policy on an annual basis.
13-43.6 APPLICABILITY:

All CCA Facilities (Provided contractual requirements do not mandate otherwise)
13-43.7 APPENDICES:

13-43AA Cardio Pulmonary Resuscitation (CPR) Drill Plan
13-43.8 ATTACHMENTS:

13-43A

Mock Cardio Pulmonary Resuscitation Evaluation Log

13-43B

Emergency Record

13-43.9 REFERENCES:

CCA Policy 4-2
ACA

4-4389M/4-ALDF-4D-08M/3-JTS-4C-28M/3-JCRF-4C-15M

NCCHC P-C-04E/J-C-04E

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13-43

JCAHO E.C.9.30
HR.2.10
HR.2.30
HRA.20
OSHA 29CFR 1910.1030

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Health Services information

CORRECTIONS CORPORATIONOFAMERICA
CORPORATIONOF AMERICA

OCTOBER 22, 2007

MARCH 13, 2006

METRO-DAVIDSON COUNTY DETENTION FACILITY
FACILIT

SIGNATURE ON F/LE AT FAC/LilY SUPPORT CENTER

Bill Andrade, MD
Chief Medical Officer
SIGNATURE ON FILE AT FAC/LllY SUPPORT CENTER

Richard P. Seiler
Executive Vice President/Chief Corrections Officer
SIGNATURE ON FILE AT FAC/LilY SUPPORT CENTER

MARCH 10, 2008

JULY 6,2006

G.A. Puryear, IV
Executive Vice President/General Counsel

13-44.1 POLICY:
Upon arrival, new inmates/residents will receive information explaining access and procedures for
health care services within the facility. This explanation will be communicated orally for those who
cannot read; for the non-English-speaking inmates/residents, information will be communicated orally
and/or in writing, in a form and language understood.
13-44.2 AUTHORITY:
CCA Company Policy
13-44.3 DEFINITIONS:
Health Services Administrator (HSA) - A person who, by virtue of education, experience, or certification,
is capable of assuming responsibility for arranging all levels of healthcare and assessing quality and
accessibility of health services for inmates/residents.
Inmate/Resident - Any adult or juvenile, male or female housed in a CCA facility. Inmates/residents
may also be referred to as detainees, prisoners, or offenders depending on classification and in
accordance with facility management contracts.
Qualified Health Services Staff (QHSS) - Includes physicians, physician assistants, nurse practitioners,
nurses, dentists, mental health professionals, and others who by virtue of their education, credentials,
and experience are permitted by law within the scope of their professional practice acts to evaluate and
care for patients.
----13-=44:-4-PROCEDtJRES:---------------.--------·-.·--.---------._----------13-=44:-4-PROCEDtJRES:------------------------·--·------------------------PROCEDURES INDEX
SECTION
A
B
A.

SUBJECT
Availability
Availabilitv
Continuing Education

AVAILABILITY
1.

The HSA or designee will ensure information pertaining to access of health care
services is posted in the intake/processing area.

2.

During the intake screening process, inmates/residents will receive health services
information, either through the Inmate Handbook or pamphlets, explaining services and
procedures for access to care.
11/8.
. . . . . . .,
,.~~~~

EXHIBIT

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B.

OCTOBER 22, 2007

13-44

3.

Access to care will be provided to inmates/residents who are unable to write in
accordance with Appendix 13-44AA Sick Call Procedure for Inmates/Residents Unable
to Write.

4.

At a minimum, information contained within the Inmate Handbook and/or pamphlets will
include:
a.

Access to care including routine sick call and emergency care;

b.

Co-Payment Procedures, when required;

c.

Prescribed Medications;

d.

Educational information pertaining to HIV, AIDS, STD's, and dental hygiene;
and

e.

Health Services Grievance Procedures.

CONTINUING EDUCATION
1.

An ongoing program of health education (to include brochures and pamphlets on a
variety of health topics) and training in self-care skills will be offered to all
inmates/residents during incarceration.

2.

Health education materials are available in the health services department upon
request or during any inmate/resident medical encounter.

3.

Training will be conducted by qualified health services staff and documented on the 1344A Inmate/Resident Health Education form.

13-44.5 REVIEW:
The Chief Medical Officer or qualified designee will review this policy on an annual basis.
13-44.6 APPLICABILITY:
All CCA Facilities (Provided contractual requirements do not mandate otherwise)
13-44.7 APPENDICES:
13-44AA Sick Call Procedure for Inmates/Residents Unable to Write
13-44.8 ATTACHMENTS:
13-44A

Inmate7ResicrenrRealtIlEClucation----·...---·-----

13-44.9 REFERENCES:
ACA

4-4344M/4-ALDF-4C-01 M/3-JTS-4C-07/3-JCRF-4C-02
4-4361/4-ALDF-4C-21/3-JTS-4C-36/3-JCRF-4C-20

NCCHC P-E-01 E/J-E-01 E
P-F-01/J-F-01
JCAHO R1.2.60
R1.2.20
R1.3.10

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Infirmary Care I Hospital Care
Page

1 of 2

CORRECTIONS CORPORATION OFAMERICA
METRO-DAVIDSON COUNTY DETENTION FACILITY

SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Bill Andrade, MD
Chief Medical Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Richard P. Seiter
Executive Vice President/Chief Corrections Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

JULY 6,2006

FEBRUARY 17, 2005

G.A. Puryear, IV
Executive Vice President/General Counsel

13-48-2.1

POLICY:
Inmates/residents requIrIng infirmary care, daily skilled nursing care, hospitalization, and/or
other specialized care, will be expeditiously transferred to the designated local licensed hospital
and/or other appropriate health care facility.

13-48-2.2

AUTHORITY:
CCA Company Policy

13-48-2.3

DEFINITIONS:
Inmate/Resident - Any adult or juvenile, male or female housed in a CCA facility.
Inmates/residents may also be referred to as detainees, prisoners, or offenders depending on
classification and in accordance with facility management contracts.
Licensed Independent Practitioners (UP) - Physicians, Physician's Assistant, Advanced
Registered Nurse Practitioner, Dentist, and Psychiatrist. Each LIP shall perform duties
according to the state scope of practice guidelines.

12-48-2.3

PROCEDURES:
PROCEDURES INDEX
SECTION
A

B
C

SUBJECT
Hospital Certification & Agreement
IransfeI
Records

HOSPITAL CERTIFICATION & AGREEMENT

O.

Each facility will have on file a copy of the hospital accreditation with the
hospital(s) utilized for inmate/resident care.

O.

Each facility will have on file a letter of agreement for services with the
hospital(s) utilized for inmate/resident care.

TRANSFER

O.

EXHIBIT

When deemed necessary by the Health Services staff, an inmate/resident may
be transferred to the designated local licensed hospital and/or other appropriate
health care facility.
AT THIS FACILITY,
INSTITUTION IS:

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THE

USUAL

PREFERRED

NON-EMERGENCY

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13-48-2

I NASHVILLE GENERAL HOSPITAL
Emergencies

O.

The HSA, at his/her discretion, may have an inmate/resident transported to the
hospital emergency department for evaluation and treatment by a hospital
Licensed Independent Provider (LIP).
AT THIS FACILITY, THE CLOSEST RECEIVING INSTITUTION IS:

I SOUTHERN HILLS MEDICAL CENTER
RECORDS
A copy of the treating facility's records (ER form, discharge summary, etc.) will be
maintained/scanned in the inmate/resident's permanent medical record.

13-48-2.5

REVIEW:
The Chief Medical Officer or qualified designee will review this policy on an annual basis.

13-48-2.6

APPLICABILITY:
All CCA Facilities (Provided contractual requirements do not mandate otherwise)

13-48-2.7

APPENDICES:
None

13-48-2.8

ATTACHMENTS:
None

13-48-2.9

REFERENCES:
NCCHC P-D-05/J-D-05
JCAHO PC.1.10

--------'=8~:-50---------------------------'=8~:-50-------------------

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__

CORRECTIONS CORPORATIONOFAMERICA
METRO-DAVIDSON COUNTY DETENTION FACILITY

SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Bill Andrade, MD
Chief Medical Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Richard P. Seiter
Executive Vice President/Chief Corrections Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

FEBRUARY 17, 2005

JULY 6, 2006

G.A. Puryear, IV
Executive Vice President/General Counsel

13-50.1 POLICY:
Upon arrival to the facility, all new inmates/residents will receive an initial medical, dental, and mental
health screening, performed by health trained or qualified health care personnel in a language fUlly
understood by the inmate/resident. Inmates/residents posing a health or safety threat to themselves or
others will be appropriately isolated from the general population.
13-50.2 AUTHORITY:
CCA Company Policy
13-50.3 DEFINITIONS:
Inmate/Resident - Any adult or juvenile, male or female housed in a CCA facility. Inmates/residents
may also be referred to as detainees, prisoners, or offenders depending on classification and in
accordance with facility management contracts.
Qualified Health Services Staff (QHSS) - Includes physicians, physician assistants, nurse practitioners,
nurses, dentists, mental health professionals, and others who by virtue of their education, credentials,
and experience are permitted by law within the scope of their professional practice acts to evaluate and
care for patients.
12-50.3 PROCEDURES:
PROCEDURES INDEX
SECIlO~

A

B
C
D

SUBJEGI
Initial Screening
In-Transit Inmates/Residents
Health Services Information
Disposition

---------------------

INITIAL SCREENING

O.

Medical, dental, and mental health screening will be performed by health trained or
qualified Health Services staff upon arrival to the facility.

O.

The initial screening will be performed in an area large enough to provide visual!
auditory confidentiality.

O.

The initial screening will include the following:

._IiIII!~~~~_lIIIIItAlnitial Health Screening
"_IIiII!~~I@lIl~_~lnitial

EXHIBIT

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Page 2 of4

MARCH 13, 2006

13-50

The 13-50A Initial Health Screening form will be utilized to document the
following information:
Vital signs;
Finger stick glucose on all diabetics;
Any signs of recent trauma (markings, contusions, lacerations, etc.);
General physical appearance including ectoparasites, lesions,
deformities, persistent cough, profuse sweating, and/or needle tracks;
Signs of intoxication;
Visible signs of alcohol or drug withdrawal;
Current medications (including supplements) and dosage;
NOTE: Personal medications of inmate/residents arriving at a CCA
facility will not be accepted unless the inmate/resident has been
transferred from another correctional entity or mental health facility, or
under special circumstances outlined in CCA Policy 13-70
Pharmaceuticals. All medications arriving with the inmate/resident will
be noted and maintained in the health services department.
Nutritional risk;
Prescribed special diets;
Visible signs of dental problems;
Visible signs of physical deformities or problems communicating
(visual, hearing, speaking);
Current and past medical history (to include illnesses, health problems,
chronic conditions, and infectious or communicable illnesses);
Alcohol and substance abuse history;
For females, urine pregnancy test on all childbearing females; last
menstrual period (LMP), gynecological problems, and number of
pregnancies/abortions;
Name and number of next of I<in;
\7Vlletller tile inmate/resiaelit-h1:fs-an-advance-directive-or-living-will;-and--Disposition.
Intake Mental Health Screening
The 13-508 Intake Mental Health Screening form will be utilized to document
the following information:
Whether present suicide ideation or history of suicidal behavior exists;
Current mental health complaints;
Current treatment for mental health problems;
History of inpatient and outpatient psychiatric treatment; and
Observation of current behavior/mental status and symptoms of
psychosis, depression, anxiety, and/or aggression.
Intake and Annual Symptom Screening

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MARCH 13, 2006

13-50

The 13-50C Intake and Annual Symptom Screening form will be utilized to
document the following information:
Comprehensive TB symptom screening; and
MRSA Screen.
IN-TRANSIT INMATES/RESIDENTS
If a facility provides housing for in-transit inmates/residents, an initial intake screening by health
trained or qualified health services staff will be completed upon arrival.
HEALTH SERVICES INFORMATION
During the initial intake screening process, inmates/residents will be provided with health
services information as outlined in CCA Policy 13-44 Health Services Information.
D.

DISPOSITION
Upon completion of the initial intake screening, the qualified health services staff will assess the
information obtained to determine the disposition of the inmate/resident. Disposition options
may include:
Immediate referral to appropriate health care services for emergency treatment (when
an inmate/resident is referred for emergency treatment, their admission to the facility is
predicated on written medical clearance);
Assignment to a medical observation cell;
Assignment to a special cell/housing unit due to special needs consideration; or
Assignment to general population.
NOTE: Disposition may be deferred, pending further information.

13-50.5 REVIEW:
The Chief Medical Officer or qualified designee will review this policy on an annual basis.
13-50.6 APPLICABILITY:
All CCA Facilities (Provided contractual requirements do not mandate otherwise)
13-50.7 APPENDICES:
None
13-50.8 ATTACHMENTS:
13-50A

Initial Health Screening

13-50B

Intake Mental Health Screening

13-50C

Intake and Annual Symptom Screening

13-50.9 REFERENCES:
CCA Policy 13-44
CCA Policy 13-70
ACA

4-4362M/4-ALDF-4C-22M/3-JTS-4C-22M/3-JCRF-4C-09M
4-4363M/4-ALDF-4C-23M/3-JTS-4C-24M
4-4364

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MARCH 13, 2006

13-50

4-4370M/4-ALDF-4C-29M
4-ALDF-4C-30M
NCCHC P-E-02E/J-E-02E
P-E-05E/J-E-05E
JCAHO PC.1.1
PC.2.120
PC.2.130
PC.5.60
PC.8.10

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Licensure/Credentialing/Continuing Education

13-56

Page

1 of 4

MARCH 13, 2006

CORRECTIONS CORPORATIONOFAMERICA

METRO-DAVIDSON COUNTY DETENTION FACILITY

SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Bill Andrade, MD
Cllief Medical Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Richard P. Seiter
Executive Vice President/Chief Corrections Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

MARCH 10, 2008

JULY 6,2006

G.A. Puryear, IV
Executive Vice President/General Counsel

13-56.1 POLICY:
All qualified health services staff will be licensed, registered, and/or certified in their respective
disciplines. Each health services staff member will maintain and provide proof of current proper
licensure/registration/certification necessary to function within his/her written job description.
All decisions and actions regarding health care services are the sole responsibility of qualified health
services staff. Decisions of a health-care-related nature will be made by the appropriate medical, dental,
mental health, or nursing personnel in accordance with applicable federal, state, and local laws, contract
provisions, policies, procedures, and health care standards.
This policy establishes guidelines and procedures for assuring proper licensure, credentialing, and
continuing education of qualified health services staff.
13-56.2 AUTHORITY:
CCA Company Policy
13-56.3 DEFINITIONS:
Auxiliary Personnel - Consultants, contracted Health Services professional specialists, and volunteers
who regularly provide service(s) to CCA.
Health Services Administrator (HSA) - A person who, by virtue of education, experience, or certification,
is capable of assuming responsibility for arranging all levels of healthcare and assessing quality and
accessibility of health services for inmates/residents.
Qualified Health Services Staff (QHSS) - Includes physicians, physician assistants, nurse practitioners,
nurses, dentists, mental health professionals, and others who by virtue of their education, credentials,
and experience are permitted by law within the scope of their professional practice acts to evaluate and
care for patients.
13-56.4 PROCEDURES:
PROCEDURES INDEX
SECTION
A

B
C
D
E

SUBJECT
Credential Requirements
Credential Verification
PrivileginQ Process
Students/I nterns
ContinuinQ Education

EXHIBIT

~

~

er
"

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OCTOBER 22, 2007

Page 2 of4

A.

CREDENTIAL REQUIREMENTS
1.

Minimum credentialing for nurses, dental hygienists, dental assistants, radiology
technicians, and mental health counseling personnel includes primary verification of the
appropriate state license/certification and inquiry into any disciplinary sanctions.

2.

Minimum credentialing for physicians, dentists, psychiatrists, psychologists, and midlevel practitioners includes:

3.

B.

13-56

a.

Primary verification of the appropriate state license;

b.

Inquiry into any disciplinary sanctions;

c.

DEA Registration Number, if applicable;

d.

State and Federal Controlled Substances Registration Certificate, if applicable;

e.

Copy of professional liability insurance policy face sheet; and

f.

Any Board Certifications, as applicable.

The Health Services Administrator will be responsible for obtaining the credentialing
packet from the Facility Support Center Health Services Department to initiate the
credentialing process, prior to the hiring process.

CREDENTIAL VERIFICATION
Licensure/registration/certification status will be verified prior to employment of any health
services professional.
1.

2.

3.

Facility Verification
a.

The applicant must provide proof of licensure to the Manager, Human
Resources/HSA.

b.

If indicated, the Health Services Administrator's credentials will be verified by
the Board of Nursing for the appropriate state.

c.

A printed copy of the verification, signed by the Health Services Administrator
or designee, will be maintained in the employee file and in the Health Services
Department.

Credentialing for physicians, dentists, psychiatrists, psychologists, and mid-level
practitioners will not be verified by the facility and will be conducted by CCA's
G0F1traGted-Grederltialirlg-ser:vice.---Re-Credentialing
Re-credentialing verification must be completed for all health services professionals a
minimum of every two (2) years or as needed.

C.

PRIVILEGING PROCESS
Facilities with JCAHO accreditation requirements will participate in the Facility Support Center
Privileging Process for all licensed, independent providers.

D.

STUDENTSIINTERNS
·1.

Upon approval of the Facility Support Center Health Services Department and the
Warden/Administrator, students and/or interns may be authorized to study in the health
services department under a written agreement between the facility and sending
training/educational facility. The written agreement must cover the scope of work,
length of agreement, and any legal or liability issues.

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Page 3 of 4

E.

13-56

OCTOBER 22, 2007

2.

Students or interns must agree in writing to abide by all facility policies, including those
relating to the security and confidentiality of information.

3.

Students and/or interns delivering health care in the facility will work under direct staff
supervision commensurate with their level of training (Le. physician, nurse, or other
appropriate health services staff).

CONTINUING EDUCATION
1.

Each member of the heath services staff will obtain all necessary and required
continuing education, specific to state licensing board requirements.

2.

All qualified healthcare professionals, inclUding contracted staff, will maintain current
CPR certification.

3.

All licensed health services staff will receive a minimum of forty (40) hours of in-service
training each calendar year, at least twelve (12) of those hours will be specific to the
health services profession. In addition to in-service training outlined in CCA Policy 4-1,
Staff Development and Training, in-service training may also consist of:

4.

a.

Core competency refresher/review;

b.

Normal instruction/in-service given by a staff member or guest lecturer;

c.

Attendance or participation in any health-related program as approved by the
HSA;

d.

Any outside continuing education program attended; or

e.

Quarterly in-service education
department.

proVided

by the

FSC

Health Services

All aUXiliary personnel will complete training appropriate to their individual assignments.
Auxiliary professional specialists in health services will complete training in accordance
with this policy and CCA Policy 13-66, Orientation Program.

13-56.5REVIEW:

The Chief Medical Officer or qualified designee will review this policy on an annual basis.
13-56.6 APPLICABILITY:

-------AII-GGA-l=aeilities-EP-revided-cQRtractual-requirements-do-notmandate_otberwise)
13-56.7 APPENDICES:

None
13-56.8 ATTACHMENTS:

None
13-56.9 REFERENCES:

CCA Credentialing Packet
CCA Policy 4-1
CCA Policy 13-66
ACA

4-4384M/4-ALDF-4D-05M
4-4085/4-4385/4-ALDF-7B-09

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OCTOBER 22, 2007

13-56

3-JTS-4C-11/3-JCRF-4C-03
4-4392/4-ALDF-4D-10
NCCHC P-C-01 E/J-C-01
P-C-03E/J-C-03E
JCAHO LD.3.50
LD.3.70
HR.4.10
HRA.20
HR.1.20
HR.2.30
HR.3.10

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371

Off-Site Care/Consultations

CORRECTIONS CORPORATIONOFAMERICA

MARCH 13,2006

METRO-DAVIDSON COUNTY DETENTION FACILITY

SIGNATURE ON FILE AT FA CILITY SUPPORT CENTER

Bill Andrade, MD
Chief Medical Officer
SIGNATURE ON fiLE AT FACILITY SUPPORT CENTER
Ricllard P. Seiter
Executive Vice President/Chief Corrections Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

JULY 6,2006

FEBRUARY 17,2005

G.A. Puryear, IV
Executive Vice President/General Counsel

13-64.1 POLICY:
Upon determining that an inmate/resident requires off-site medical, dental, or psychiatric consultation
and/or services, the Health Services staff will make all necessary arrangements for the appropriate
appointment within a reasonable time frame based on acuity of condition.
13-64.2 AUTHORITY:
CCA Company Policy
13-64.3 DEFINITIONS:
Emergent - Performed/seen within one (1) hour.
Licensed Independent Practitioners (LIP) - Physicians, Physician's Assistant, Advanced Registered
Nurse Practitioner, Dentist, and Psychiatrist. Each LIP shall perform duties according to the state scope
of practice guidelines.
Urgent - Performed/seen within seventy-two (72) hours
Routine - Performed/seen within eight (8) to twelve (12) weeks.
13-64.4 PROCEDURES:
PROCEDURES INDEX
SECTION
A

B

B.

P-r.ovide~s

Requests
Scheduling
Transport Coordination
Return to Facility
Documentation

C
D
E
F

A.

SUBJECT

PROVIDERS
1.

A written list of off-site referral sources, including emergency and routine care, will be
posted in the Health Services Department.

2.

The HSA will be responsible for ensuring the list is reviewed annually and updated as
necessary.

REQUESTS

EXHIBIT

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MARCH 13, 2006

13-64

All routine off-site service request are entered electronically (via the Oracle System), reviewed
by the Utilization Review Physicians (or customer) and either approved, pended, or denied.
C.

D.

E.

SCHEDULING
1.

Once approved, the appointment is scheduled locally with the appropriate off-site
provider.

2.

Inmates/residents will
times.

not be provided advanced notice of specifics or appointment

TRANSPORT COORDINATION
1.

Health Services staff will arrange/coordinate medical appointment transports with the
department responsible for coordinating transports.

2.

Medical appointments will not be cancelled or postponed without prior
consultation with the HSA or designee.

3.

Prior to departure of the transport, the health services staff will provide transportation
officers with the following information:
a.

The 13-868 Special Instruction for Transporting Officer, if necessary.

b.

The 13-64A Consultation Form.

c.

The 13-648
applicable).

Off-Site

Transportation

Information/Payment

Request

(if

RETURN TO FACILITY
All inmates/residents returning to the facility from an emergency, acute hospitalization, or urgent
consultation will be seen by Health Services staff for appropriate housing placement.

F.

DOCUMENTATION
1.

Upon conclusion of the medical appointment, transport officers will obtain a copy of the
off-site proVider information.

2.

Transport officers are responsible for returning all medical documents to the Health
Services Department upon return to the facility.

3.

Inmates/residents will not be allowed to maintain any medical paperwork during the
transport.

4.

AIHinBmgs from off:Site consult~nrr'rdlorh-()spital-discharge-orders-will-be-reviewed-andi---­
consult~nrr'rdlorh-()spital-discharge-orders-will-be-reviewed-and---­
initialed by the facility physician/LIP. He/she will either approve or amend any orders in
accordance with CCA policy, procedure and practice.

5.

All abnormal findings are to be reported to the LIP/physician and signed off with
notation in the medical record.

13-64.5 REVIEW:
The Chief Medical Officer or qualified designee will review this policy on an annual basis.
13-64.6 APPLICABILITY:
All CCA Facilities (Provided contractual requirements do not mandate otherwise)
13-64.7 APPENDICES:
None

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Page 3 of 3

MARCH 13, 2006

13-64

13-64.8 ATTACHMENTS:
13-64A

Consultation Form

13-64B

Offsite Transportation Information/Payment Request

13-86B

Special Instructions for Transporting Officer

13-64.9 REFERENCES:
CCA Policy 13-86
ACA

4-4348/4-ALDF-4C-05
4-4349/4-ALDF-4C-06
3-JTS-4C-34

NCCHC P-A-03E/J-A-03E
P-D-05/J-D-05
P-E-1 0/J-E-1 0
P-E-12/J-E-12
JCAHO LD.3.50

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Physician
iciara Orders ami Provider Protocols

13-11

CORPORATIONOFAMERICA
CORRECTIONS CORPORATIONOF
AMERICA

MARCH 13, 2006

Page

1 of 3

JANUARY 1, 2005

METRO-DAVIDSON COUNTY DETENTION FACILITY

SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Bill Andrade, MD
C/lief Medical Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Richard P. Seiter
Executive Vice President/Chief Corrections Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

JULY 6, 2006

FEBRUARY 17, 2005

G.A. Puryear, IV
Executive Vice President/General Counsel

13-71.1 POLICY:
The issuance of and compliance with direct medical orders by licensed Health Services staff will be
consistent with applicable statutes, standards, and protocols governing treatment of inmates/residents.
CCA will comply with all applicable state law and appropriate medical practice with regard to direct
medical orders and establish a basic set of treatment guidelines within accepted general standards of
care.

13-71.2 AUTHORITY:
CCA Company Policy

13-71.3 DEFINITIONS:
Direct Medical Orders - Written instructions to licensed nursing staff by a legally authorized practitioner
directing a specific action/treatment to be carried out.
Provider Protocols - Guidelines for provider evaluation and management of a specific set of
symptoms/conditions. Such protocols describe actions/treatments based on generally accepted
standards of care and which are within legal limitations of the individual provider's license, and do not
confer any additional privileges upon the user of the protocol.
Verbal/Telephone Orders - Instructions, by a legally authorized practitioner, to licensed nursing
personnel that are communicated orally, face-to-face, by telephone, or by other auditory devices.

13-71.4 PROCEDURES:
PROCEDURES INDEX
SECTION
A
B
C

A.

SUBJECT
Direct Medical Orders
Patient Care Protocols
Provider Protocols

DIRECT MEDICAL ORDERS
Providers who are authorized by law or regulation to issue direct medical orders will:
1.

Legibly write and sign all direct medical orders on the 13-718 Physician's Order Sheet
or verbally communicate such orders to appropriately licensed health care personnel
and countersign them manually or electronically as soon a possible, but no later than
the next available clinic visit.

EXHIBIT

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MARCH 13, 2006

Page 2of3

B.

C.

13-71

2.

Verbal and/or telephone orders should be limited to situations where immediate written
or electronic communication is not feasible.

3.

Verbal and/or telephone orders should be confirmed, written without abbreviations and
be repeated back to the prescriber.

4.

Faxed copies of signed orders can be accepted as signed originals.

5.

Modifications to direct medical orders must be authorized by an appropriately LIP.

PATIENT CARE PROTOCOLS
1.

The 13-71A Patient Care Protocols have been established by the Facility Support
Center Health Services staff and will be maintained and used in every facility's Health
Services Department.

2.

The facility Health Services staff is responsible for verifying that all appropriate staff is
thoroughly familiar with the protocols contained in 13-71A.

3.

The facility LIP or Health Services staff may request addition protocols or revisions to
existing protocols by contacting the Regional Director, Health Services. Written
permission from the Chief Medical Officer must be on file prior to additions/revisions to
any protocols.

4.

The Patient Care Protocols will be reviewed and approved annually by the HSA and
facility physician.

PROVIDER PROTOCOLS
Per state law, physicians who provide supervision of an ARNP or PA will have agreed upon
protocols that guide treatment decisions.

13-71.5 REVIEW:
The Chief Medical Officer or qualified designee will review this policy on an annual basis.
13-71.6 APPLICABILITY:
All CCA Facilities (Provided contractual requirements do not mandate otherwise)
13-71.7 APPENDICES:
None
13-71.8 ATTACHMENTS:
13-71A

Patient Care Protocols

13-71 B

Physician's Order Sheet

13-71.9 REFERENCES:
ACA

4-4376M/4-ALDF-4C-36M
4-4382M/4-ALDF-4D-03M/3-JTS-4C-12M/3-JCRF-4C-04

NCCHC P-E-11/J-E-10
JCAHO MM.3.20
MMA.10
IM.6.50

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MARCH 13,2006

13-71

LD.5.50
LD.5.60
LD.5.70
LD.5.80

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Scope of Seli"Vices
Page

1 of2

JANUARY 1, 2005

CORRECTIONS CORPORATIONOFAMERICA

METRO-DAVIDSON COUNTY DETENTION FACILITY

SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Bill Andrade, MD
Chief Medical Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Richard P. Seiler
Executive Vice President/Chief Corrections Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

FEBRUARY 17, 2005

JULY 6,2006

G.A. Puryear, IV
Executive Vice President/General Counsel

13-77.1 POLICY:
Every inmate/resident will have access to health care services from admission to discharge from the
facility providing for the physical and mental well-being of the population. These services exclude
elective therapies except when those procedures correct a substantially functional deficit or if an
existing pathological process threatens the well-being of the inmate/resident over a period of time.
13-77.2 AUTHORITY:
CCA Company Policy
13-77.3 DEFINITIONS:
Anesthesia Services - The administration (in any setting, for purpose by any route) of, (1.) general,
spinal, or other major regional anesthesia; or (2.) sedation, with or without analgesia, that in the manner
used may be reasonably expected to result in the loss of protective reflexes.
Elective Therapy - A treatment, procedure, or surgical procedure not requiring immediate attention and
therefore planned for the patient's convenience.
13-77.4 PROCEDURES:
PROCEDURES INDEX
SECTION
A

B
C

A.

SUBJECT
Health Care Services
-ElecthLaTl1eraR.v.LI[aatment
Anesthesia

HEALTH CARE SERVICES
1.

2.

The follOWing health care services will be provided at each facility:
a.

Medical and dental services;

b.

Mental health services;

c.

Nursing;

d.

Personal Hygiene;

e.

Dietary Services; and

f.

Health Education.

Health care services will be offered through the following:

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3.
B.

MARCH 13, 2006
a.

Established sick-call systems;

b.

Screenings;

c.

Chronic Care Clinics;

d.

Dental Care;

e.

Mental Health Care;

f.

Off-Site Care and Consultation;

g.

Observation Care;

h.

Emergency Care; and

i.

Health Education Programs.

13-77

Health care services (treatments/procedures/consultations) not available within the
confines of the facility's medical program will be provided off-site.

ELECTIVE THERAPY/TREATMENT
Elective procedures will be evaluated on a case-by-case basis. The facility physician will
provide a case presentation to the Chief Medical Officer or designee if a case is referred for
treatment or surgery.

C.

ANESTHESIA
Anesthesia (except for local anesthesia) services are not performed in any CCA medical
department.

13-77.5 REVIEW:
The Chief Medical Officer or qualified designee will review this policy on an annual basis.
13-77.6 APPLICABILITY:
All CCA Facilities (Provided contractual requirements do not mandate otherwise)
13-77.7 APPENDICES:
None
13-77.8 ATTACHMENTS:
None
13-77.9 REFERENCES:
ACA

4-4347/4-ALDF-4C-04
4-4398/4-ALDF-4D-16

NCCHC P-A-01 E/J-A-01 E
P-D-05/J-D-05
JCAHO PC.5.10

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Sick Call
Page

1 of 4

CORRECTIONS CORPORATION OF
AMERICA
OFAMERICA
METRO-DAVIDSON COUNTY DETENTION FACILITY
ME:TR'O-DAVIDSON

SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Bill Andrade, MD
Chief Medical Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

Richard P. Seiter
Executive Vice President/Chief Corrections Officer
SIGNATURE ON FILE AT FACILITY SUPPORT CENTER

MARCH 10, 2008

JULY 6,2006

G.A. Puryear, IV
Executive Vice President/General Counsel

13-80.1 POLICY:
Every CCA facility will have a formal Sick-Call System whereby an inmate/resident with a health care
request will have unimpeded access to individualized and appropriate health care for non-emergency
illness or injury in a clinical setting. This policy establishes procedures and describes the system
through which inmates/residents can request and receive individualized and appropriate health services
for non-emergency illnesses or injuries.

13-80.2 AUTHORITY:
CCA Company Policy

13-80.3 DEFINITIONS:
Health Services Administrator (HSA) - A person who, by virtue of education, experience, or certification,
is capable of assuming responsibility for arranging all levels of healthcare and assessing quality and
accessibility of health services for inmates/residents.
Licensed Independent Practitioner (LIP) - Physicians, Physician's Assistant, Advanced Registered
Nurse Practitioner, Dentist, and Psychiatrist. Each LIP shall perform duties according to the state of
scope practice gUidelines.

Medical Request Slips/Sick-Call Slips - A method whereby inmates/residents have access to medical,
dental, and mental health attention for illnesses/injuries/requests of a non-urgent nature by means of an
appointment.
I RlAGE--=-Tne sorting ounrrrd--classiffcatiorrot-inmateJresident-patient-health-e0ff1plaints-te-deteFminei- - - priority of need and proper place of health care.

13-80.4 PROCEDURES:

PROCEDURES INDEX
INDEX
PROCEDURES
SECTION
A
B
C
D
E

A.

EXHIBIT

SUBJECT
Schedule
Secure Drop Boxes
Sick Call Requests
Sick Call Clinic
Co-Payment

SCHEDULE
Sick call will be scheduled at least five (5) days a week by a qualified health care
provider.

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a.

B.

C.

13-80

At NCCHC accredited facilities, in addition to the five (5) days a week, a
physician or physician extender is recommended to be on site a minimum of
five (5) hours per week for everyone-hundred (100) inmates.

2.

Physician/LIP referrals are to be scheduled within one (1) week of the request, or as
clinically indicated.

3.

The Sick-Call Schedule will be posted in each housing unit.

SECURE DROP BOXES
1.

Secure labeled drop boxes will be available in centrally located areas for Sick Call
Req uest forms.

2.

The number of drop boxes should be determined by the HSA based on the size and
design of facility.

3.

Only Health Services staff will have access to the secured drop boxes.

SICK-CALL REQUESTS
1.

Sick Call Request forms (13-80A1 for Non Co-Payor 13-80A2 for Co-Pay) will be
located in the housing units for easy accessibility.

2.

Any inmate/resident wishing to schedule an appointment during scheduled sick call will
complete the appropriate Sick Call Request form.
a.

If an inmate/resident is unable to write, the inmate/resident can ask for
assistance with completion of the request.

3.

Upon completion of the Sick Call Request form, the inmate/resident will place the form
in the secure drop box.

4.

A member of the Health Services staff will pick up Sick Call Requests on each shift or at
least every twenty-four (24) hours.

5.

Sick Call Request forms will be TRIAGED and appropriate referral made according to
clinical need.
a.

If the request does not appear to be an emergency, the inmate/resident will be
evaluated by the appropriate health care provider within forty-eight (48) hours
of the request (seventy-two (72) hours on weekends).

b.

A response is written on each appropriate slip copy indicating the planned

-----------------::aJTis::-::p:.-::o~S·!Tlt;::IO-=n-.
------------------=::a~is~p;.;O~S·~lt;.;IO:;;n.:... 7"iS:rlJcp=-Cs=-=a=re:-s~e=-Oaleashut
7"s:rlJcp:::-:s~a;;:re;.s~e~aleashut anareturnea-totl1einffrate/rEfstdtmrand-may~---

indicate approximate date and time of scheduled appointment.
i.

c.

6.
D.

The request and response are noted in the inmate/resident's medical
record and the original request slip placed/scanned in the medical
record, unless otherwise mandated by contractual requirements.

If an inmate/resident completes a Sick Call Request for the same complaint
more than twice and has not been evaluated by a physician/physician extender,
the inmate/resident will receive an appointment to do so.

The inmatelresident's name is placed on the appropriate log.

SICK CALL CLINIC
1.

During Sick-Call Clinic, nursing, dental, and mental health staff will triage, evaluate, and
recommend treatment within the constraints of their licensure and the CCA Patient Care
Protocols. Problems beyond their scope of practice are referred to the appropriate
health care provider.

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E.

13-80

2.

In the event that the inmate/resident's custody status (e.g., administrative segregation)
precludes attendance at the regularly scheduled Sick-Call Clinic, the inmate/resident
will still be seen where housed.

3.

During Sick Call Clinic, the Health Services Department will accommodate unscheduled
inmates/residents with conditions that require immediate attention (e.g., acute illness,
injury, etc.).

4.

Health services staff will make daily rounds in segregation to ascertain health care
needs. The presence of the qualified health services staff in segregation will be
announced and recorded in the appropriate log(s) and/or using the 13-428 Daily
Medical Segregation Checks form. A notation will be documented manually or
electronically in the medical record if treatment is provided.

5.

Treatments ordered by an LIP will be transcribed onto the 13-808 8P Treatment
Record, 13-80C Diabetic Monitoring Treatment Record, or 13-80D General
Monitoring/Treatment Record, as appropriate.

6.

Sick call and other requests for dental services will be logged onto the 13-80E Dental
Request Log if answered by dental. A copy of the request is placed/scanned in the
medical/dental record and an entry is made in the 13-13D Dental Progress Notes
indicating the date the request was received, date answered, and disposition of the
inmate/resident.

CO-PAYMENT
1.

If medical co-payment fees are imposed in accordance with the facility management
contract, the following will be observed:
a.

All inmates/residents will be advised, in writing, at the time of admission to the
facility of the guidelines of the co-payment program.

b.

Needed inmate/resident healthcare will not be denied due to lack of available
funds.

c.

Co-payment fees shall be waived when appointments or services, including
follow-up appointments, are initiated by Health Services staff.

d.

AT THIS FACILITY, ADDITIONAL CONTRACTUAL PROCEDURES FOR COPAYMENT FEES ARE AS FOLLOWS:
$3.00 TO BE SEEN IN SICK CALL AND $3.00 FOR MEDICATION. THERE
IS NO CHARGrTO~CFlROI\ITC-CCINIC
OR CHRONIC-ctINlc-l1- - MEDICATIONS.

13-80.5 REVIEW:
The Chief Medical Officer or qualified designee will review this policy on an annual basis.
13-80.6 APPLICABILITY:
All CCA Facilities (Provided contractual requirements do not mandate otherwise)
13-80.7 APPENDICES:
None
13-80.8 ATTACHMENTS:

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OCTOBER 22, 2007

13-80

13-80A1 Sick Call Request (Non Co-Pay) - English and Spanish
13-80A2 Sick Call Request (Co-Pay) - English and Spanish
13-80B

BP Treatment Record

13-80C

Diabetic Monitoring Treatment Record

13-800

General Monitoring/Treatment Record

13-80E

Dental Request Log

13-130

Dental Progress Notes

13-80.9 REFERENCES:
ACA

4-4344M/4-ALDF-4C-01 M/3-JTS-4C-07/3-JCRF-4C-02
4-4345/4-ALDF-4C-02
4-4346/4-ALDF-4C-03/3-JTS-4C-30
4-4362/4-ALDF-4C-22M/3-JTS-4C-22M/3-JCRF-4C-09M
4-4363/4-ALDF-4C-23M/3-JTS-4C-24M
3-JTS-4C-08
3-JTS-4C-09

NCCHC P-C-07/J-E-07
JCAHO PC.5.50
PC.5.60
PC.6.10

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